HIV and AIDS have had a devastating effect on family food security and household wealth in sub-Saharan Africa through the debilitation of the most productive household members, decreased household income, and increased caregiver burden. Children under five living in households affected by HIV and AIDS are at high risk for food insecurity and its subsequent negative impacts on nutrition, somatic growth, illness, and development. While interventions to increase food security and reduce poverty may be effective for those outcomes, there is little prior research on the impact of those interventions on the health and development of young children living in those HIV-affected households. The objective of this project is to determine the impact of an agricultural intervention targeting HIV-affected households in Nyanza Province, Kenya, on important health measures for children under five years old, including nutritional status, disease incidence, and development. This project will take advantage of existing resources, infrastructure, and a cohort provided by an NIH-funded pilot intervention study, 'Shamba Maisha' (R34 MH094215, PIs: Weiser and Cohen, the parent study). Shamba Maisha is an agricultural intervention that centers around the provision of a KickStart foot-operated mechanical irrigation pump, a microeconomic loan, and training in sustainable farming techniques and financial management provided by the Kenyan Ministry of Agriculture. The parent study will include 120 HIV-infected adults (60 intervention and 60 control) from two rural communities. The parent study aims to assess the impact of Shamba Maisha on household food security, economic indicators, primary health outcomes, HIV transmission risk, and women's empowerment. The present project will assess the impact of Shamba Maisha on behavioral outcomes, including child diet, health care utilization of caregivers for children, child-care-related behaviors (e.g., immunizations, hygiene practices, and use of insecticide-treated bednets) and child health outcomes, including growth, disease, and development for children, age 0 to 59 months old, of the HIV-infected adults in the parent study. Children's HIV status will be ascertained, and children will be followed for one year and assessed at regular intervals for the outcomes of interest. Our specific aims are to: Aim 1. Assess the preliminary impact of Shamba Maisha on behavioral outcomes among HIV-affected children ages 0 to 59 months old. Aim 2. Assess the preliminary impact of Shamba Maisha on the primary child health outcomes of interest for the planned cluster RCT on HIV-affected children ages 0 to 59 months old. Aim 3. To understand the acceptability and feasibility of conducting health and developmental assessments at children's homes, and translate lessons learned in the development study into the design of a cluster RCT. PUBLIC HEALTH RELEVANCE: Children in households affected by HIV and AIDS are at high risk for food insecurity and undernutrition. This project will examine the impact of an agricultura intervention targeting HIV-affected households in Nyanza Province, Kenya on somatic growth, disease incidence and development of children age 0 to 59 months. The project has the potential to improve the ways in which sustainable development and HIV health care and prevention services are conceptualized and delivered throughout rural Africa by demonstrating the role of sustainable agricultural and economic development in improving the health of HIV-affected children.